Assessment and treatment of dementia in older adults
A systematic review finds that brief cognitive assessment tools can adequately detect early dementia, but whether interventions for mild cognitive impairment or early dementia have a clinically significant effect is unclear.

Ibuprofen compared with indometacin for patent ductus arteriosus
A Cochrane review reports that ibuprofen is as effective as indometacin for closure of patent ductus arteriosus in preterm or low-birthweight babies, and is associated with a lower risk of necrotising enterocolitis, reduced time on assisted ventilation and a lower risk of negative effects on renal function.

Collaborative care for depression
A cluster randomised controlled trial in English general practices suggests that collaborative care delivered by mental health workers acting as care managers is more effective at reducing depression than usual care.

Venous thromboembolic diseases -Interventions to reduce substance misuse among vulnerable young people

Eyes on Evidence helps contextualise important new evidence, highlighting areas that could signal a change in clinical practice. It does not constitute formal NICE guidance. The commentaries
included are the opinions of contributors and do not necessarily reflect the views of NICE.

E-cigarette awareness and use to quit smoking
A survey suggests that awareness and use of e-cigarettes has increased over the past few years, but a randomised controlled trial indicates that the products are only modestly effective at helping people to quit smoking.

Beta-2 agonists and exercise-induced asthma
A Cochrane review has assessed the effects of short and long-acting beta-2 agonists for the prevention of exercise-induced asthma in adults and children; the majority of included studies assessed the effect of a single dose of a beta-2 agonist. The Medicines and Healthcare Products Regulatory Agency has previously issued advice recommending that long-acting beta-2 agonists should not be prescribed for the relief of exercise-induced asthma symptoms in the absence of regular inhaled corticosteroids.

Risk factors for congenital abnormalities
A prospective study of a UK multi-ethnic birth cohort suggests that consanguinity is a major risk factor for congenital abnormalities, in particular in children of parents of Pakistani origin.

Blood oxygen levels in preterm infants
One randomised controlled trial reports that preterm infants with low blood oxygen levels have higher mortality at discharge than infants with high levels. However, a second randomised controlled trial finds no difference in mortality on the basis of blood oxygen level.

Premature mortality in people with epilepsy
A Swedish total population study finds that people with epilepsy are at increased risk of premature death, with the risk even higher among those with psychiatric disorders.

Small benefits of Z drugs over placebo for insomnia
A meta-analysis has found that Z drugs reduce the time taken to fall asleep by 22 minutes compared with placebo. However, this result may not be clinically significant and any benefit of Z drugs must be balanced against their well-documented risks.

Since you last received Eyes on Evidence our name has changed to the National Institute for Health and Care Excellence, to reflect our new role and responsibilities. NICE’s role is to improve outcomes for people using the NHS and other public health and social care services.

The prevalence of infectious diseases, such as tuberculosis, HIV and hepatitis C, in homeless populations is significantly higher than in the general population. However, figures show much local variation raising questions about the need for a more locally-based response.

Risk of abuse in disabled children A systematic review of studies from across the world suggests that more than a quarter of children with disabilities will experience abuse within their lifetimes and that children with disabilities are 3 to 4 times more likely to be victims of abuse than their peers without disabilities.

Rheumatoid factor and risk of future rheumatoid arthritis A cohort study reports that raised levels of rheumatoid factor are associated with an increased risk of developing rheumatoid arthritis. Although treating pre-rheumatoid is currently of unproven value, this study suggests it might be possible in the future.

Heart failure: effects of aldosterone antagonists and renin-angiotensin antagonists on mortality An observational study in people admitted to hospital with heart failure (HF) with reduced ejection fraction finds that aldosterone antagonists reduce readmissions for HF but have no effect on mortality and increase the risk of admission with hyperkalaemia. Another observational study in people with HF with preserved ejection fraction finds that angiotensin converting enzyme inhibitors or angiotensin receptor blockers reduced all-cause mortality.

Grapefruit–drug interactions A review article details the evidence for a pharmacokinetic interaction between grapefruit and certain drugs, and the potential clinical consequences of this.

The QIPP Collection highlights examples of local best practice, demonstrating how NHS organisations have implemented new practices that have both cut costs and improved quality. We highlight 2 new examples:

Analysis of data from a large randomised controlled trial suggests that intensive glucose control in critically ill patients is associated with moderate to severe hypoglycaemia, and a higher risk of death.

A cross-sectional study investigating a possible link between harsh physical punishment and mental health disorders reports that reducing physical punishment may help to reduce the prevalence of mental health disorders in the general population. It suggests giving parents information about alternative discipline strategies, such as positive reinforcement.

The QIPP Collection highlights examples of local best practice, demonstrating how NHS organisations have implemented new practices that have both cut costs and improved quality. We highlight a new example:

An analysis of the impact of New York City policy to restrict the use of trans fat for human consumption shows a significant fall in the trans fat content of fast food purchases, without a commensurate rise in the level of saturated fat.

A systematic review and meta-analysis show that the molecular detection of tumour cells in regional lymph nodes is associated with an increased risk of disease recurrence and poor survival in patients with node-negative colorectal cancer.

Results of a randomised controlled trial show that offering either additional free nicotine replacement therapy or higher intensity proactive telephone counselling to people who rang a national helpline for support to stop smoking, did not increase quit rates over and above those obtained using standard helpline support.

A Cochrane review concludes that antihypertensive drugs have not been shown to reduce mortality or morbidity in adults with mild hypertension and no previous cardiovascular events. Significantly more people taking antihypertensive treatment discontinued treatment due to adverse effects, compared with placebo. However, the review has some significant limitations.

People who are admitted to hospital with a psychotic disorder may have their illness misclassified. Diagnosis should be reassessed periodically to ensure that the most appropriate interventions are being used.

There may be differences in mortality risk between individual antipsychotic agents used to treat people with dementia. Patients should be monitored for adverse events in the acute treatment period, and periodic attempts to discontinue medication should be made.

Caution is urged over the long-term use of antiplatelets in people with chronic kidney disease. Treating 1000 patients with oral antiplatelet therapy for a year may prevent nine heart attacks, but this needs to be balanced against an increased risk of bleeding.

Pregnant women may experience some benefit from using relaxation techniques during labour, in relation to reduced pain, increased satisfaction and improved clinical outcomes. However, the available evidence is insufficient to make clinical recommendations.

There is no strong evidence of a clinically important difference in efficacy between antimuscarinic drugs. The choice of antimuscarinic drug for an individual woman is likely to depend on tolerability, patient preference, and cost.

Venous thromboembolism (VTE) is a condition in which a blood clot (a thrombus) forms in a vein. Embolism occurs when the thrombus dislodges from its site of origin and travels in the blood.

VTE is an important and preventable cause of morbitity and mortality, with almost a third of survivors experiencing long term effects. To improve survival and prevent complications, the occurence of VTE needs to be reduced.

Current advice: NICE guidance on reducing the risk of VTE in patients admitted to hospital, highlights the need for new research to develop and validate risk prediction models for use by primary care research databases.

Although there are currently no validated algorithms to predict risk for VTE designed for use in primary care, computerised clinical decision support could improve appropriate use of thromboprophylaxis in a hospital setting.

Extended VTE prophylaxis is a research recommendation in the current NICE guidance and features in the VTE NICE Quality Standard.

Overview: People with learning disabilities have poorer health than their non-disabled peers and evidence suggests that this is partly because of barriers associated with identifying ill health and ensuring timely access to healthcare services (Michael 2008).

Overview: Psoriasis is a skin condition in which skin cells reproduce too quickly, causing red, flaky, crusty patches with silvery scales. It affects about 2% of the UK population and is a chronic condition that often goes through cycles and can return at any time. There are several clinical variants of psoriasis, including plaque, guttate, erythrodermic and pustular. Plaque type is the most common form, accounting for 80% of cases. Psoriasis runs in families, although the exact role of genetics in the condition is unclear. The inflammatory processes of psoriasis are not fully understood but it is known that levels of tumour necrosis factor-alpha (TNF-alpha) are elevated in the skin of people with the condition.

NHS Evidence provides access to more than 300,000 reliable resources from 1,300 sources. The number of evidence providers we receive information from is increasing every month.

Fact sheets from the Meningitis Trust are a recent addition to the search. The resources are primarily patient support information and cover a range of issues including developmental difficulties following meningitis, recovering after leaving hospital, entitlement to statutory benefits, and coping with bereavement. There are also fact sheets written specifically for child carers, teachers and pupils, employers, colleges and universities, and health professionals.

The Meningitis Trust was one of the first charities to become a certified member of The Information Standard.